Job Application - Certified
High Plains Educational Cooperative
Job Application for Certified Employees
Email address *
Date *
MM
/
DD
/
YYYY
Name *
First, Middle, Last, Maiden
Social Security # *
Permanent Mailing Address *
City, State, Zip *
Phone number *
Present Mailing Address
City, State, Zip
Phone Number
Position(s) for which you are applying for? (in order of preference)
1. *
2. *
Types of certificates held
1. Type
State
Date Issued - Date Expired
2. Type
State
Date Issued - Date Expired
3. Type
State
Date Issued - Date Expired
If you do not hold a teaching certificate, when will you be eligible for one?
Have you ever been dismissed or denied a contract? *
Have you ever been convicted of a felony? *
KPERS
Kansas Public Retirement System
Are you currently enrolled in KPERS? *
Are you currently receiving a monthly KPERS Retirement check? *
Race & Ethnicity
Ethnic Group - (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) *
Race Category - Select all the general racial category(ies) *
Required
Authorization
1. I certify that all the information provided by me in the application is true and complete. I understand that any misstatements, falsification, or omission of information is grounds for refusal to hire or, if I am hired and the same is discovered thereafter, termination.

2. I authorize any of the persons or organizations referenced in the application to give you any and all information concerning my previous employment, education, or any other information, personal or otherwise, with regard to any of the subjects covered by this application, and I release all such information to you. I authorize any background checks by any third party.

3. I authorize HPEC to request, receive, and verify all information given on this application and I release HPEC from all damages that may result from your doing so.

By entering my name below, I authorize the information above *
Upload Documents
Transcript, Teaching Certificate, Recommendations/References, Resume
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